Brooke Army Medical Center Sports Medicine
Outpatient Rehabilitation Protocol
Small (< 1cm) & Medium (1-3 cm) Rotator Cuff (1 tendon) Repairs
Supraspinatus or Subscapularis
Arthroscopic & Open Procedures
BAMC Ortho: 210-916-1242
BAMC PT: 210-916-1920
This Rehab Protocol is a guideline. Specific exercises and time frames may be altered
depending on patient progression except italicized and bolded items.
General Rehab Considerations:
 Rehab may need to be modified/slowed based on the following considerations:
o Size of repair
o Quality of tissue and integrity of repair (must be communicated to the therapist by
the surgeon)
o Age >50
o Acute vs. chronic tear
o Revision surgery vs. first surgery
o Pain
 Early passive ROM is essential to prevent capsular adhesions and loss of motion; should
be done in a manner that shortens the involved tissue
o Supraspinatus: Avoid passive IR past the plane of the body, horizontal adduction,
and extension for 4 weeks. May be modified based on guidance from surgeon.
o Subscapularis: Avoid excessive passive external rotation (none past neutral),
horizontal adduction, and extension for 6-8 weeks. May be modified based on
guidance from surgeon
INPATIENT: Post-operative day (POD) 1 through discharge (d/c) from hospital
PT Sessions: Afternoon visit after surgery and daily supervised sessions
Sling:
1.
2.
Exercises:
1.
2.
3.
Shoulder immobilizer / abduction sling (Donjoy “Ultrasling”)
Wear at all times, even when sleeping for 1st 4 weeks after surgery
Remove 3x/day for PT exercises, and for personal hygiene
Grip Strength w/ foam ball, towel, putty to squeeze repetitively
Hand, wrist, elbow full active range-of-motion (AROM)
Shoulder passive pendulum exercises in sling or forearm supported
4.
5.
Assisted passive range-of-motion (PROM) of shoulder to maximum of
45 flexion, 30 external rotation (neutral for subscapularis), 45
abduction; NO extension
Pt indep with cryotherapy use at least 3 x day at home
PHASE I: Hospital d/c through Week 4 – PROTECTION PHASE
PT Sessions: 2-3 supervised sessions per week with physical therapist
Sling:
1.
2.
Exercises:
1.
2.
3.
4.
5.
6.
Shoulder immobilizer / abduction/IR sling (Donjoy “Ultrasling”)
Wear at all times, even when sleeping for 1st 4 weeks after surgery
Remove 3x/day for home PT exercises, and for personal hygiene
Grip Strength w/ foam ball, towel, putty
Hand, wrist, elbow full AROM w/ light weights (1-3 lbs.; incr. prn)
Modified passive pendulum exercises in sling or forearm supported
Supine assisted PROM shoulder to tolerance (with a goal of 90 flexion,
45 external rotation(neutral for subscapularis), 90 abduction by the 4th
week); NO extension
Scapular retraction; gently pinch shoulder blades together for 5 sec
Postural correction exercises
Aerobic Conditioning: may ride stationary bike while wearing immobilizer
Continue Cryotherapy
PHASE II: Week 4 - 8 – EARLY STRENGTHENING & ENDURANCE
PT Sessions: 2-3 supervised sessions per week with physical therapist
Sling:
Wean shoulder immobilizer / sling
Exercises:
1.
2.
3.
4.
5.
6.
7.
8.
Continue grip strength exercises
Continue hand, wrist, elbow full AROM w/ weights
Passive pendulums w/ elbow extended and forearm unsupported
Supine and active assisted ROM to maximum tolerance; include
wand/stick, pulley, wall climbs, assistance from opposite UE, etc…
DO NOT PUSH THROUGH ANY SHARP OR STABBING PAIN
Active assisted range-of-motion (AAROM) for ER and gentle IR
Scapular retraction and protraction (pinch/spread shoulder blades)
Cross chest (posterior capsule) stretch
Gentle ADL’s at or below waist level; NO sudden movements
Subscapularis repairs: Neutral ER for 6-8 weeks, no active IR for 8 weeks
Small repairs: May initiate gentle AROM and RC theraband exercises if ROM
goals are being met and pain is well-controlled at 4 weeks.
Medium repairs: May initiate gentle AROM and RC theraband exercises if
ROM goals are being met and pain is well-controlled at 6 weeks.
Aerobic Conditioning: Stationary bike or treadmill while wearing sling
Criteria for Progression to PHASE III:
1.
90% Full PROM
2.
Pain-free ADL’s up to chest height
PHASE III: Week 8 - 12 – ADVANCED STRENGTHENING & ENDURANCE
PT Sessions: 2-3 supervised sessions per week with physical therapist
Sling:
none
Exercises:
1.
2.
3.
4.
Continue previous grip and hand/wrist/elbow AROM exercises
Progress from AAROM to AROM; emphasize terminal stretching
Gentle shoulder AROM and rotator cuff strengthening; use theraband
Moderate ADL’s from waist to shoulder; NO overhead activity
Subscap PROM to 30 degrees
Aerobic Conditioning:
1.
Stationary bike, elliptical trainer, stairmaster
2.
May walk on treadmill; NO running
3.
Upper body cycle up to 5 min forward and 5 min backward
Criteria for Progression to PHASE IV:
3.
90% shoulder FAROM (except subscap repair)
4.
Pain-free ADL’s up to shoulder height
5.
Able to perform 5 min of upper body cycle w/o pain
PHASE IV: Week 12 - 16 – BASIC FUNCTIONAL PHASE
PT Sessions: 1-2 supervised sessions per week with physical therapist
Exercises:
1.
2.
3.
4.
5.
Continue all previous exercises
Address all residual strength and ROM impairments
a. Capsular stretches as needed
b. Progressive resistance exercises for shoulder girdle complex
Full ADL’s with no lifting > 10 lbs.
Basic aquatic (pool) therapy if available
Slowly advance motion into ER with subscap
Aerobic Conditioning:
1.
2.
May begin jogging (if painfree)
Upper body cycle up to 10-15 min forward and 10-15 min backward
Criteria for Progression to PHASE V:
1.
Full or nearly full shoulder AROM
2.
Near full strength per manual muscle testing
3.
Pain-free basic functional training exercises
PHASE V: Week 16 - 24 (6 mo) – ADVANCED FUNCTIONAL PHASE
PT Sessions: 1-2 supervised sessions per week with physical therapist
Exercises:
1.
2.
3.
Full AROM exercises to fatigue
Gradually increase weight training to maximum; must be pain free
Advanced pool therapy if available
Aerobic Conditioning:
1.
Progress from jogging to running prn; should be pain-free
2.
Sport or activity-specific drills prn; i.e. throwing, catching, swinging
PHASE VI: 6 Months + – RETURN TO FULL DUTY PHASE
When rehabilitation goals are met:
1.
Full shoulder AROM (accept 5-10 loss of ER)
2.
Full strength per manual and isokinetic testing
3.
Able to pass APFT, including push-ups
______________________
JAMES R. FICKE, MD
COL, MC
Chief, Orthopedics
___________________________
KATHLEEN S. ZURAWEL, PT, OCS
COL, SP
Chief, Physical Therapy
APPROVE / DISAPPROVE
APPROVE / DISAPPROVE
Updated 30 October 2006